Q. Managing diarrhoea in children?

Managing diarrhoea in children is of great concern. The guidelines for the same are as follows:

1. The first objective is to rehydrate the child. Thus using ORS would be the ideal modality. The WHO-ORS standard preparation is useful but recent studies have suggested that the osmolarily of the solution should be reduced from 311mmol/ Litre to 200-250 m mol/litre by reducing the concentration of glucose. Sodium has a beneficial effect on the stool output and duration especially in non-cholera diarrhoea. This can be achieved by diluting the ORS salt in 1.5 litres instead or the usual 1 litre for infants under age 2 months.

2. Breast feeding should be continued in young infants during diarrhoea. This helps in decreasing the number and volume of stools and the duration of diarrhoea. Starving the child during diarrhoea may deteriorate the nutritional status.

3. Children 4-6 months of age or older should receive energy rich mixture of soft weaning foods in addition to breast milk. The energy rich mixture can be a mix of cereal, pulse, roots, green leafy vegetables, and fats like ghee, butter that are easy to digest. The caloric density of the feeds can be increased by using amylase rich flour (ARF), i. e the flour obtained from germinated grain which is rich in amylase and call be prepared as a soft and thin porridge without taking away its nutritional value. Fermented foods like dhokla, bread, idli, dosa may be included in the diet.

4. Foods to be avoided include: spicy and oily foods, confectionary, mithai and chocolates, as well as, uncooked fruits and vegetables.

5. Supplementation with B-complex vitamins especially folic acid, vitamin B,, and minerals like zinc help in normalizing the intestine.

6. The criteria for monitoring the state of hydration and nutritional status are: good urine output, appearance of the eyes, skin, buccal mucosa and weight gain.

7. Consult the doctor, if required.